Provider Demographics
NPI:1447022058
Name:IBARRA, BREANNA (AAC)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:IBARRA
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 SE IRELAND ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5502
Mailing Address - Country:US
Mailing Address - Phone:360-679-7676
Mailing Address - Fax:360-682-5947
Practice Address - Street 1:830 SE IRELAND ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5502
Practice Address - Country:US
Practice Address - Phone:360-679-7676
Practice Address - Fax:360-682-5947
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61094516171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator